05/02/2023
Childhood Obesity is an epidemic.
A recent article published in JAMA Pediatrics discusses the American Academy of Pediatrics (AAP) clinical practice guideline for the evaluation and treatment of children with obesity. The AAP guideline emphasizes weight loss drugs and bariatric surgery despite limited research on novel dietary obesity treatment in any age group. Although the physiologic actions of anti-obesity drugs and surgery may have similarities to diet, few high-quality studies have been conducted to test novel dietary obesity treatments. However, low-glycemic load diets have shown promise in delaying hunger after eating, which may augment satiety induced by the direct actions of long-acting GLP-1 RA in the brain. A low-glycemic load diet also decreases leptin levels, suggestive of lower leptin resistance, and ghrelin levels and increasing adiponectin levels. Similarities between low-glycemic load diets and the GLP-1 RA include the slowing of gastric emptying, which reduces overall insulin demand. The efficacy of low-glycemic load diets in weight loss may approach the efficacy of the GLP-1 RAs in weight loss, but high-quality clinical trials will be needed to know the full potential of low-glycemic load diets. The article argues that the justified excitement surrounding new-generation weight loss drugs should not lead to deprioritizing development of nonpharmacologic interventions aimed at the root causes of the epidemic.
This Viewpoint considers the best approaches for treating obesity in youth and argues that better funding is needed for new dietary treatments and reimbursement for behavioral interventions.